New Hope for Prostate Cancer

Androgen deprivation therapy (ADT) has been a mainstay for prostate cancer treatment since the 1950s. But a warning last year from the FDA based on recent studies showing that ADT might cause deadly heart attacks really put the kibosh on this treatment with some doctors.

While most docs thought the risk was worth the benefit for the most serious patients—those with metastatic disease, or tumors that spread—they were unclear whether ADT was worth it for patients whose disease was aggressive but hadn’t spread.

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If this is the boat you’re in, rest assured: A new study in this week’s Journal of the American Medical Association suggests that all that drama might have been for nothing. Results show that ADT doesn’t appear to raise the risks of cardiac death, and it might increase your chances of living longer.

The study’s researchers combed through more than 1,000 studies on patients who received ADT. They narrowed their focus to eight prospective randomized controlled trials—considered the gold standard for medical research. These studies began when patients started receiving ADT and compared them to similar patients who received all the same treatments minus ADT.

The findings showed that among patients who got ADT and those who didn’t, the rate of cardiac death was almost identical, at around 11 percent. That number didn’t change even when they factored in other variables, including how long patients were on ADT, if they were old, or if they received other treatments such as radiation.

When they compared how many patients died from prostate cancer, only 13 percent in the ADT group died, versus 22 percent in the non-ADT group—suggesting that ADT has a real benefit in treating prostate cancer, say study researchers Toni Choueiri, M.D., and Paul Nguyen, M.D., of the Dana–Farber Cancer Institute of Brigham and Women’s Hospital.

So why did the FDA issue a warning against ADT? It was based on mostly studies that scanned databases looking for patients on ADT who died from heart-related reasons—a study design that could be rife with errors.

“For the majority of men with aggressive prostate cancer, hormonal therapy is associated with better survival without an apparent increased risk of heart attacks,” Choueiri says. “That should be reassuring to the vast majority of men who need this therapy for their prostate cancer.”

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But before you ask for ADT, keep a couple things in mind: Nguyen says that the study didn’t test whether men who are already at high risk for a heart attack might have an even higher risk on this therapy—that’s something they plan to study in the future. And ADT does have other side effects that can affect your health in other ways. For example, it’s linked with insulin resistance, a precursor to diabetes. Before you go on ADT, discuss all the pros and cons with your doctor.

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